Missouri to implement transgender health care limitations for adults, minors

The Missouri attorney general announced new limitations Thursday on gender-affirming care for minors and adults in a move that has sparked outrage from advocacy and LGBTQ groups.

Attorney General Andrew Bailey's limitations would require adults to attend 18 months of psychological or psychiatric assessments via a therapist before receiving gender-affirming care “to explore the developmental influences on the patient’s current gender identity and to determine, among other things, whether the person has any mental health comorbidities.”

Providers also would need to prove that "the patient has exhibited a medically documented, long-lasting, persistent and intense pattern of gender dysphoria" for at least three years, according to the announcement.

A spokesperson for the attorney general's office Madeline Sieren told the Associated Press that the restrictions would apply to both minors and adults.

LGBTQ advocates slammed Bailey's decision to restrict the health care available to both adults and minors, arguing that Bailey's announcement is based in discrimination and not science.

"The Attorney General’s claims are maliciously cherry-picked and come from unverified sources that allow him to promulgate disgusting, obstructive and misleading information into an emergency rule," said PROMO, Missouri’s LGBTQ+ public policy and advocacy organization, in a statement to ABC News.

Bailey’s announcement focuses on the risks associated with gender-affirming care, but physicians have told ABC News that all medications, surgeries or vaccines for any kind of treatment come with risk and gender-affirming care is no different.

They say knowing the risks and benefits of treatment – and of not treating a condition – can help families and individuals make an informed decision.

Major national medical associations, including the American Academy of Pediatrics, the American Medical Association, the American Academy of Child and Adolescent Psychiatry, and over 20 more agree that gender-affirming care is safe, effective, beneficial and medically necessary.

Due to gender-related discrimination and gender dysphoria, trans youth are more likely to experience anxiety, depressed mood and to think about or attempt suicide. Gender-affirming hormone therapy has been found on average to improve the mental health of transgender adolescents and teenagers, according to a recent study in the New England Journal of Medicine.

Gender dysphoria refers to the stress of being in a body that doesn’t feel like one’s own.

Though Bailey calls puberty blockers “experimental" in his announcement, drugs in the class have been FDA approved since the 1990s to treat early puberty. They are not specifically approved to treat gender dysphoria, but have been studied and commonly prescribed for that purpose for decades.

Modern gender-affirming care is based on “decades of clinical experience and research and, therefore, they are not considered experimental, cosmetic or for convenience,” per the World Professional Association for Transgender Health standards of care.

Studies have also shown that it’s rare for people to reverse a transition after undergoing gender-affirming care, according to research in the journal LGBT Health which also found that those who reverse their transition often do so because of pressures from family and social stigma.

Rates of regret for gender-affirmation surgery are extremely low — research shows they hover around 1%, according to the Plastic and Reconstructive Surgery medical journal. Rates of regret for knee and hip surgeries are significantly higher, studies show.

Bailey also cited the high mortality rate for transgender people in his announcement. Studies in the Duke University Press, the National Cancer Institute and Lancet Diabetes & Endocrinology have shown that transgender people face economic and social marginalization, violence and discrimination at a higher rate than non-transgender people — that research asserts that these issues likely play a role in the persistence of poor health and higher mortality in the community.

The research asserts that these issues likely play a role in the persistence of poor health and higher mortality in the community.

Bailey's announcement comes amid an investigation into a St. Louis transgender health care center that is accused by a whistle-blower of "using experimental drugs on children," distributing medication "without individualized assessment" and "without parental consent," according to the attorney general's office.

The center said it was "alarmed by the allegations."

The emergency regulation is effective starting April 27 until February 6, 2024.

"We are taking this matter very seriously and have already begun the process of looking into the situation to ascertain the facts," Washington University's Transgender Center said in a statement. "As always, our highest priority is the health and well-being of our patients. We are committed to providing compassionate, family-centered care to all of our patients and we hold our medical practitioners to the highest professional and ethical standards."

Civil rights organizations including Lambda Legal and the American Civil Liberties Union of Missouri vowed to pursue litigation against the move from the attorney general's office.

“Gender-affirming care is critical in helping transgender adolescents succeed in school, establish healthy relationships with their friends and family, live authentically as themselves, and dream about their futures," the organizations said in a joint statement. "We will defend the rights of transgender people through any necessary legal action, just as we have done in other states engaging in this anti-science and discriminatory fearmongering.”

Gender-affirming care for youth has been restricted in at least 12 states.